Provider Demographics
NPI:1164539276
Name:DURHAM, SUSAN RAY (DPH)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:RAY
Last Name:DURHAM
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 509
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:AL
Mailing Address - Zip Code:35592-0509
Mailing Address - Country:US
Mailing Address - Phone:205-695-9611
Mailing Address - Fax:
Practice Address - Street 1:44801 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:AL
Practice Address - Zip Code:35592-0509
Practice Address - Country:US
Practice Address - Phone:205-695-9611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10524183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist